To floss or not to floss? Dental hygiene has always lacked confidence
Are rags better than sticks? Are brushes better than rags?
Last week, after an Associated Press article questioned the efficacy of flossing, federal health agencies withdrew their endorsement of the practice. According to the report, the benefits of flossing—part of the Dietary Guidelines for Americans since 1979—are yet to be confirmed by science.
A whole generation that had grown up being flogged about floss was unburdened.
But, this week the dental establishment bit back. In a piece posted online, Scott Froum (DDS), editorial director of Perio-Implant Advisory e-newsletter writes that “the studies used to come up with the assessment by the Associated Press were flawed, short term, or not deemed credible levels of evidence.”
It turns out, in the grand story of oral hygiene, uncertainty, ambiguity, and contention of this sort are simply part of the norm.
Dental history has its fair share of odd trials, but what’s striking is how many are hard to dismiss. Some ancient tools to keep one’s teeth clean, such as feathers, porcupine quills, and animal bones, are not sorely missed. But the same can hardly be said of the “chew stick,” a plant twig modified to retain a bristle-like end for cleaning teeth. For all its age, the chew stick, or miswak, is still used in parts of Africa today. You can even buy them online.
By the middle ages, Europeans had adopted diligent oral hygiene habits. And contrary to the stereotype of the toothless-peasant, they were actually quite effective. The prevailing custom of the day involved cleaning the teeth and gums with linen, supplemented by a paste of salt or charcoal, with herbs like mint, rosemary, and sage added for freshness. Hygiene practices like these (as well as a diet low in sugar), kept medieval teeth relatively healthy, with some samples showing fewer signs of decay than their 20th Century counterparts.
Bristle brushes, which had been around for centuries in China and Japan, began to enter the Western purview in the 1600s. They were not embraced immediately. Pierre Fauchard, the revered “father of modern dentistry,” who was wise to advocate for braces and the avoidance of sugar, nonetheless preferred toothpicks or a sponge soaked in water or brandy over brushing.
In fact, the construction of the early toothbrushes, which were typically made from hog bristles, made the act of brushing an unpleasant chore for hundreds of years. Many people avoided brushing until the development of synthetic bristles as late as the 1930s; instead they preferred to use cloth.
One 19th Century dentist endorsed brushing, but did not trust it to complete the job, recommending the additional use of waxed silk. In 1845, The American Journal of Dental Science put its authority behind flossing — not brushing — as the dental hygiene method of choice.
Disagreements over proper oral care are centuries old, and ultimately mirror our own. On one hand, research science may provide “weak” and “unreliable” support for flossing, while on the other, dental professionals come equipped with heaps of anecdotal evidence in favor of the practice, for reasons like plaque removal and treating bad breath.
It would appear that the old advertising trope — four out of five dentists agree! — exists for a reason. No matter the era, consensus around proper dental hygiene can be frustratingly hard to find.
Chew sticks, anyone?
